Early treatment after stroke decreases risk of permanent brain damage

DEAR MAYO CLINIC: If you get to the hospital quickly after having a stroke and get treatment right away, does that mean there won't be any of the typical after-effects of a stroke?

ANSWER: Although early treatment doesn't guarantee that there won't be any lasting effects from a stroke, it can dramatically decrease the risk of permanent brain damage. If you have any symptoms of a stroke, get emergency medical care right away.

There are two types of stroke. The first, called an ischemic stroke, is due to a lack of blood supply to an area of the brain caused by a blocked artery. This deprives brain tissue of oxygen. Within minutes, the brain cells begin to die. Ischemic strokes make up about 85 percent of all strokes.

The second type of stroke involves bleeding in the brain. An artery bursts, and blood spills into the brain tissue, causing brain damage. That's called a hemorrhagic stroke. These make up about 15 percent of strokes. Both kinds of stroke can lead to serious brain damage and disability.

Symptoms of a stroke usually show up quickly. Key symptoms include sudden weakness on one side of the body, face, arm or leg, or sudden numbness in part of your body, particularly your face, arm or leg. If you suddenly have difficulty speaking or understanding others as they speak, or sudden unsteadiness in your walking, that could signal a stroke. A stroke also may cause vision problems, such as the inability to see in one eye or to one side, or cause double vision. Some types of stroke are associated with head pain and may cause a sudden, severe headache. But many strokes do not cause pain.

If you have any of these symptoms, you need immediate medical care. There are treatments available that can stop a stroke in its tracks but they must be started soon after a stroke happens.

The treatment you get depends on the kind of stroke you have. An imaging test known as a computed tomography (CT) scan can help doctors see if there is bleeding in the brain. When a person suspected of having a stroke arrives at the hospital, a CT scan usually is done very quickly to see if the stroke is ischemic or hemorrhagic.

For an ischemic stroke, caused by a lack of blood supply to the brain, medications can sometimes dissolve the blood clot that's blocking an artery. If used early enough, this treatment restores blood flow to the brain tissue and provides brain cells with the oxygen they need to survive.

To be most effective, the clot-dissolving medication needs to be given within about four and a half hours of the time the stroke started. If a patient is seen just beyond this time window, other therapies can be used that deliver the clot-dissolving medication directly to the blocked area using a small plastic tube called a catheter. Or in some cases, a tiny device may be able to remove the clot directly from inside the artery.

For the less common type of stroke that involves bleeding, the treatment is different. In some circumstances, surgery can be done to remove the blood. In other cases, bed rest, close observation and aggressive medical care in a hospital may be more appropriate.

With any stroke, no matter which type it is, quick treatment is critical. Currently, many people who have a stroke don't get to a doctor or hospital until 24 hours after the stroke has started. That's too long to wait. If you have any of the symptoms of a stroke, call 911 or go to a hospital emergency department without delay. — Robert Brown, Jr., M.D., Neurology, Mayo Clinic, Rochester, Minn.